The present invention relates to medical apparatus and pertains particularly to an improved percutaneous gastrostomy kit.
Many medical patients who have lost the ability to swallow may have an intact gut and require long-term nutritional support. The conventional approach to this problem has been to place a gastrostomy surgically or to leave a nasogastric tube in place for long periods.
A recent approach to this problem has been the placement of a gastrostomy tube endoscopically. This permits the placement of a gastrostomy tube through a much smaller opening in the walls of the stomach avoiding general anesthesia and the use of an operating room. This most recent approach is discussed in a publication entitled "Percutaneous Endoscopic Gastrostomy" by David E. Larson, M.D., et al., published by the Mayo Clinic, Proc 58: 103-107, 1983. This publication describes a procedure wherein the site of placement of gastrostomy is located by an endoscope with an opening made into the skin and abdominal wall by a scalpel blade and then a 16-gauge Medicut catheter introduced through the opening into the stomach and a silk suture passed through the catheter and grasped with a standard biopsy forceps with the suture and endoscope then removed from the patient in a conventional fashion. Thread from the mouth of the patient is then backfed through a first Medicut sheath and then through a second sheath which has been inserted through the proximal end of a modified 16-F Pezzer "mushroom" catheter. The second sheath is removed and discarded, the thread left in place and the Medicut sheath is then pulled over the catheter to protect the knot and serve as a dilator. The catheter is then lubricated and pulled through the mouth, esophagus, stomach, and finally, abdominal wall until only the rubber bumper and mushroom head remain in the stomach. A rubber bumper is specially prepared for the catheter by cutting a hole through an elastic tube and inserting the catheter through the hole such that the tube extends transverse to the axis of the catheter. This procedure requires the time consuming assembly and preparation of several separate components in preparation for the operation.
It is desirable that an improved kit be available having the necessary components with desirable modifications for simplifying and improving the gastrostomy procedures.